Oral Herpes

What is oral herpes?

Oral herpes is a type of herpes simplex virus (HSV) infection that affects your mouth area. Small blisters (cold sores) form on and around your lips in episodes known as outbreaks. Your first outbreak may occur within a week or two of getting infected with HSV. Or it may not occur for months or even years later. So, it’s possible to have an oral herpes infection and not realize it for some time.

Learning you have oral herpes might feel unsettling. That’s because people often assume “herpes” is a sexually transmitted infection (STI). But while you can get oral herpes from sexual contact, it most often spreads through non-sexual contact (like when an adult with a cold sore kisses a child). It’s also important to keep in mind that STIs in general are common and spread easily. So, whether you have oral herpes, genital herpes or any type of STI, you’re not alone and your diagnosis doesn’t say anything about who you are as a person.

Other names for oral herpes (pronounced “AWR-uhl” “HER-peez”) include:

• Oral-facial herpes.
• Herpes labialis.

What are the signs and symptoms of oral herpes?

Cold sores are the most common sign of an oral herpes infection. Cold sores usually form on or around your lips, especially along the outer edge where your lip meets the skin next to it. But they can also form on your cheeks, chin or nose. When you’re first infected with HSV (primary infection), you might have other symptoms, too. These include:

• Fever.
• Swollen lymph nodes in your neck.
• Sore throat.
• Redness and swelling in your throat.
• Sores along the back of your throat.
• Painful sores inside your mouth, including on your gums, tongue and roof of your mouth (palate).

Some people get infected but don’t have symptoms (asymptomatic). So, it’s possible to carry HSV for a while and not realize it until your first cold sore pops up.

After the primary infection (symptomatic or asymptomatic) clears up, HSV stays dormant in nerve cells in your head. You won’t even know the virus is there. People often say the virus is “asleep.” This is because it usually doesn’t cause any symptoms for long stretches of time. But every now and then, the virus “wakes up.” When it does this, it causes a cold sore outbreak.

A cold sore outbreak usually involves a cluster of small blisters that form in the same general area as the primary infection. You may feel tingling, numbness, itching or pain on your lip or surrounding skin before the cold sores appear. Healthcare providers call this the prodromal (pronounced “proh-DROH-mul”) stage. The prodromal stage is a warning sign that cold sores are about to form.

People who are immunocompromised may have more severe oral herpes outbreaks, including painful sores inside their mouth or throat.

What does oral herpes look like?

With an oral herpes outbreak, you’ll notice fluid-filled blisters on your face, typically on your lips or close to your mouth. The blisters look like tiny bumps, and the skin around them may be discolored, swollen and painful.

After a couple of days, the blisters break open and a clear or slightly yellow fluid oozes out. A day or so later, the sores stop oozing and a golden-brown crust forms on top of the sores. The crust may occasionally crack open or bleed. Within about two weeks from the start of the outbreak, the crust falls off. The skin underneath may look slightly pink or red for several days until it fully heals.

What causes oral herpes?

Oral herpes is a viral infection, and the herpes simplex virus (HSV) is the specific virus responsible. There are two types of HSV (HSV-1 and HSV-2). Both types can cause oral herpes, but HSV-1 causes most cases.

How do you get oral herpes?

You get oral herpes when your mouth area comes into contact with someone else’s infected skin or saliva (even without any visible symptoms or lesions), or a shared object. This may occur when you:

• Kiss someone who has a cold sore.
• Share an object like a cup, spoon/fork or lip balm with someone who has a cold sore.
• Perform oral sex on someone who has genital herpes (HSV in the genital area can spread to the mouth area).

Oral herpes infections occur in people of all ages, but it’s common for them to happen during childhood. This is because oral herpes spreads to children through contact with adults — like if an adult with a cold sore gives a child a peck on their lips or shares a cup with them.

Is oral herpes contagious?

Yes. Oral herpes is very contagious. This is because the virus that causes it (HSV) spreads easily through skin-to-skin contact and saliva.

What are the complications of this condition?

Oral herpes infections can sometimes lead to serious complications, including HSV infections in:

• Your eyes (ocular herpes).
• Your brain or the membranes covering your brain and spinal cord (HSV encephalitis, meningitis or meningoencephalitis).
• Skin elsewhere on your body, like your fingers (herpetic whitlow).

If you have atopic dermatitis, oral herpes can lead to an infection called eczema herpeticum. This is when the virus spreads from your mouth area (or someone else’s mouth area) to a part of your skin that atopic dermatitis affects. Because there are breaks in your skin, it’s easy for HSV to enter and spread.

These issues can occur with a primary infection or later on when HSV reactivates.

How do healthcare providers diagnose oral herpes simplex?

Healthcare providers diagnose oral herpes infections through a physical exam and testing. During an exam, your provider will evaluate your mouth area and ask you what you’ve noticed. They may easily recognize cold sores or other signs of oral herpes.

Your provider may take a sample of fluid from your cold sores to send to a lab for testing. This can confirm or rule out an HSV infection and is more commonly performed if you’re immunocompromised.

If you don’t have an active outbreak but want to know if you’re carrying HSV, your provider may order a blood test to check for antibodies against HSV-1 or HSV-2. If you have antibodies in your blood, that means you’ve had a primary HSV infection in the past and the virus may reactivate in the future.

What is the treatment for oral herpes?

There’s no cure for oral herpes. But antiviral medications are a mainstay of treatment.

When it comes to antivirals, here are the available options:

• Topical medications. These are creams you apply to the affected area. You can get some over-the-counter, while others require a prescription.
• Oral medications. These are medications you take by mouth. They require a prescription. Your provider may prescribe oral antivirals for a single outbreak. This is called episodic therapy. It doesn’t lower your risk for future outbreaks or make them less severe. If you get frequent or severe oral herpes outbreaks, your provider may prescribe antivirals for you to take every day. This is called chronic suppressive therapy. Chronic therapy may reduce how often you get oral herpes outbreaks and make those outbreaks less severe.

Besides antivirals, you can get topical anesthetics without a prescription. These are creams or gels you apply to the affected area that numbs your skin. They’re a quick, temporary fix for pain or discomfort, but they won’t affect the outbreak’s severity or duration.

How to get rid of oral herpes quickly

Antiviral medications can make an oral herpes outbreak go away faster. These medications are most helpful when you take them within the first 48 hours of a cold sore forming. As soon as you notice the telltale tingling or itching on your lip or surrounding skin, call your provider. They can help you get treatment fast.

Can oral herpes be prevented?

HSV spreads easily between people, so it’s not always possible to prevent an oral herpes infection. But you can lower your risk by:

• Not sharing anything that touches someone else’s mouth, including kitchenware or lip balm. This is a good rule to follow whether or not someone has a cold sore. Lots of common germs spread easily through saliva and could make you sick.
• Not kissing someone with an oral herpes outbreak.
• Avoiding oral-to-genital contact with someone who has a genital herpes outbreak. It’s also important to avoid genital-to-genital or other skin contact to avoid getting genital herpes or other HSV infections.

What can I expect if I have oral herpes?

Oral herpes affects everyone a little differently. Some people have frequent cold sore outbreaks, while others have them rarely. In general, most people get fewer outbreaks as they get older. But you may notice certain things trigger a cold sore outbreak — like being sick or experiencing a lot of stress.

No matter your situation, a healthcare provider can recommend the best treatment for you. Your provider can also explain what complications could arise from oral herpes and help you manage your risk.

When should I see my healthcare provider?

Call a provider if you have an oral herpes outbreak and any of the following are true:

• It’s your first outbreak.
• You have other symptoms besides cold sores, including sores inside your mouth or a fever.
• You’re interested in prescription antiviral therapy.
• You have a medical condition (like HIV) or are taking a medication that suppresses your immune system.
• You have atopic dermatitis.
• You notice changes to how your eye area looks or feels (this could be a sign of ocular herpes).
• It’s a severe outbreak or you feel you get outbreaks often.

Can you get herpes from oral sex?

Yes. Oral sex can spread herpes (the herpes simplex virus) in two different ways:

• You can get oral herpes by performing sex on someone who has genital herpes. HSV can spread from your partner’s genital area to your mouth area, giving you oral herpes.
• You can get genital herpes if someone who has a cold sore performs oral sex on you. This means oral herpes can cause genital herpes.

If your partner has cold sores, you should avoid all contact with their mouth area until the sores fully heal. If your partner has genital herpes sores, you should avoid all contact with their genital area until the sores fully heal.

Protection like condoms and dental dams can make it harder for HSV to spread, but they don’t fully protect you from genital or oral herpes infections. Still, they’re vital for lowering your risk of catching other sexually transmitted infections.

Is oral herpes an STD?

Oral herpes is sometimes a sexually transmitted infection (STI). For example, you may develop oral herpes if you perform oral sex on someone with genital herpes. But oral herpes most often spreads through non-sexual contact.